The management of type 2 diabetes in the United States is costly, complex, and continues to fall short of evidence-based goals for glycemic, blood pressure, and cholesterol control. Effective interventions to improve management must be grounded in a clear understanding of how care is currently delivered and must overcome barriers to making changes in therapy. Dr. Grant's long-term goal is to become an independent clinical and health services researcher in diabetes care, with a focus on translating evidence-based guidelines into effective clinical management. Aided by advanced coursework in epidemiology, biostatistics, and medical informatics, Dr. Grant will perform a series of analyses using epidemiologic data to assess the impact of complex medical regimens on medication adherence and to define and describe predictors of medical regimen change in patients with diabetes. The clinical insight resulting from these analyses will help inform the design and implementation of a randomized clinical trial to improve diabetes care. This trial will evaluate the impact of linking medication adherence data derived from current pharmacy claims directly to the electronic medical record in order to guide clinical decisions regarding medical therapy. The Specific Aims of this research proposal are: Specific Aim 1: To assess the impact of complex medical regimens on medication adherence in the treatment of hyperglycemia, hypertension, and hyperlipidemia. Specific Aim 2: To identify predictors of therapy change among patients with elevated glycemic, blood pressure, or cholesterol levels. Specific Aim 3: To design and implement an informatics-based randomized controlled trial to improve diabetes risk factor management by providing primary care physicians with pharmacy claims-based adherence data as part of the electronic medical record. This career development award will allow Dr. Grant to acquire additional research skills and experience under the mentorship of nationally and internationally known researchers in a supportive academic environment. Completing these objectives will enhance his ability to conduct patient-centered research and to achieve his goal of becoming an independent patient-oriented researcher in diabetes care